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Solution Manual for Skills in Clinical Nursing 8th Edition

Berman Snyder 013399743X 9780133997439
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5 CLIENT HYGIENE
Chapter 5 focuses on the knowledge and skills the nurse needs to
know in order to provide personal hygiene for the client. Emphasis
is on promotion of cleanliness and comfort involving care of the
skin, hair, feet, teeth, oral cavity, ears, and perineal-genital areas.

SUGGESTED DISCUSSION QUESTIONS, LAB, AND CLINICAL

ACTIVITIES
1. Ask students to discuss their bathing practices, e.g., how often, type (shower, bath), when
(AM vs. PM).
2. Ask students who have been bathed by another person to describe their experience. Ask
those who have not been bathed by another, what concerns would they have during the
process. Would a client have similar concerns?
3. How could the nurse communicate caring to a client prior to, during, and after a bath?
4. How does touch influence the various aspects of client hygiene?
5. What is the procedure for providing perineal and genital care for males and females? How
would the nurse alter the procedure for a client with limited range-of-motion of the lower
extremities?
6. When should the nurse wear gloves for hygienic care?
7. What are some nursing concerns related to hygiene that are associated with clients’ age and
developmental level?
8. What would you want the nurse to know before you received oral hygiene?
9. What are the assessment criteria and the procedure for cleansing the mouth of an
unconscious client?
10. What assessment criteria would indicate a client should be referred to a podiatrist?
11. Ask students to discuss their personal hair care. If they were ill and could not do their own
hair care, what would they want their caregiver to do for them?
12. How does the nurse apply principles of medical asepsis when providing hygiene care for
clients?
13. Invite an occupational therapist to discuss techniques and equipment used to increase the
bathing independence of clients who are physically challenged.
14. Assign pairs of students to perform oral care, bed bath, and backrub with a specified time
frame (e.g. 45 minutes) to assist the students to practice organizing these skills prior to
performing them in the clinical setting.
15. Have students use different oral care products (foam swab, lemon-glycerine swab) in
addition to a toothbrush when performing oral care on each other.
16. Bring a hearing aid to lab; have students practice cleaning it and changing the battery.
17. Critique the products available for hygienic care in the clinical facility, including no-rinse
soaps or shampoos, powder, hand soap, oral care applicators, lotion, and hair care products.
What is the process for obtaining specialized products if they are needed?
18. Assign all students to perform a complete bed bath and oral care on a dependent client in
the clinical setting.
19. Examine agency policies regarding foot care. Discuss foot care and assessment criteria for
clients who have diabetes or peripheral vascular disease.
20. Have students observe a staff nurse performing hygienic care unfamiliar to them such as
shaving of male clients, denture care, or care of hearing aids.
21. Have students evaluate their client’s functional level and identify nursing interventions that
will promote the client’s independence.

FOCUSING ON CLINICAL THINKING

Consider This
1. An unlicensed assistive person comes to you and informs you that a client “refuses her
bath.” The UAP tells you that the client has an unpleasant body odor and her hair is oily
and matted. What should you do?
2. A client complains of not being able to hear after the cleaning of his hearing aid. What
should you do?
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 THE KIND BROTHER.

Boy. Where is James.

Lady. He is in the house; you may go to him there.
Boy. If you please, I like to stay here.
Lady. What shall we do?
Boy. I wish to have my knife and a stick; then with this small piece
of board I will make a chair for Jane’s doll.
 Lady. That will please Miss Jane; that piece will do for a couch;
you might stuff it with wool.
Boy. I wish I could; pray will you teach me how to do it?
Lady. If you make the frame well, I will stuff it for you.
Boy. Thank you; I think Jane will dance for joy.
Lady. She does not dream of such a nice chair; stay, this is the
right way to cut it; you must not notch it so.
Boy. I think I hear Jane’s voice; I would not have her come till it is
done. Will she thank me?
Lady. Yes, sure; she ought to thank you.
Boy. Why does she sleep in the day?
Lady. She is a babe—you slept at noon, when you were so young.
Boy. Now I do not sleep till night. I hear my ducks; what do you
quack for?—May I fetch them some bread? Here is a crust which I
left; pray may I give it to them?
Lady. If it be clean, some poor child would be glad of it; that is a
large piece—We will give chaff to the ducks.
Boy. This bread is made of wheat; wheat grows in the earth; wheat
is a grain. I am to see Tom bind a sheaf: and when Tom goes home
to shear his sheep, I am to see him. He will throw them in a pond:
plunge them in! Our cloth is made of wool; how can they weave
cloth, and how can they stain it? How light this chair will be! it will not
weigh much.
Lady. Who heard the clock; I meant to count it. I left my watch in
my room.
Boy. Why did you leave it?
Lady. The chain was broken last night.
Boy. I like to have my couch of green. Jane loves green. What do
you call this?
 Lady. A blush, or faint bloom; some call it bloom of peach; it is
near white. That is quite white.
Boy. May I sit on the grass? I love to sit in the shade, and read my
book.
Lady. The earth is as dry as a floor now.
Boy. If I could reach those sweet peas I would get some seed;
they are such nice round balls. Jane likes them to play with.
Lady. You may go now and fetch a quill for me; do not put it in your
mouth. While you go, I shall go on with the work.
 THE BEES.

A little girl was eating her supper; it was bread and milk, with some
honey. “Pray,” said the little girl, “who makes honey for my supper?”
Mother. The bees collect it.
Girl. Where do they find it?
Mother. In the flowers.
Girl. Where do the bees live?
Mother. Those which supply us with honey, live in a hive.
Girl. What is it made of?
Mother. Ours are made of straw.
Girl. Pray, mamma, tell me a great deal about the bees, whilst I eat
my milk.
Mother. In the night, and when the weather is cold, they keep in
the hive. When the sun shines, and the days are warm, they fly
abroad. They search far and near for such flowers as supply them
with honey or wax. Of the wax they make cells which we call comb.
In some of the cells they lay up stores of honey to support them in
the winter, when they can not venture out to seek for food. In some
of the cells they nurse their young ones, who have no wings. They
are very neat creatures; they keep the hive quite clean. They carry
out the dead bees.
 THE FLIES.

The next morning this same little girl was eating her breakfast. It
chanced that the maid had let fall a drop of honey as she mixed her
milk; and a fly came and stood on the edge of her basin to suck it.
The good child laid aside her spoon to avoid frightening the poor
fly.
What is the matter, Sarah? are you not hungry?
Yes, mamma; but I would not hinder this little fly from getting his
breakfast.
Good child! said her mother, rising from her tea; we will look at him
as he eats. See how he sucks through his long tube. How pleased
he is!
Mother, can not flies make honey? said the little girl.
“No,” said her father, “they are like you, they can not make honey,
but they are very fond of eating it.”
What do flies do, father?
Father. They are as idle as any little girl of you all; they frisk and
buzz about all the summer, feeding upon what is made by others.
Girl. And in winter what do they do?
Father. Creep into some snug corner.
Girl. But what do they eat then?
Father. They sleep, and want no food.
 THE SPIDER.

A little boy saw a spider; its legs were all packed close to its body;
the boy thought it was a bit of dirt, and was going to pick it up.
His father stopped him, lest he should chance to hurt the spider;
he told him that the poor creature had rolled himself up from fear;
that if he stood still he would soon see the spider move.
The little boy kept close and quiet some time, watching the spider;
he saw it unfold one leg, then another, till at last they were all loose,
and away it ran. Then the little boy ran after his father, and heard the
history of spiders.
He told him a great deal about them. Then he talked to him of
other insects, which disguise themselves to escape the dangers
which they meet with.
He picked up a wood-louse, and laid it gently in his little hand.
There, said he, you see the wood-louse roll itself into a little ball, like
a pea: let it lie awhile and when it thinks that you do not observe it—
Boy. Ah! it unrolls.—O! it will run away: shall I not hold it?
Father. No, my dear, you would hurt it.
Boy. I would not hurt any creature.
Father. No! surely—He who made you, made all creatures to be
happy.
 THE BIRD.

A boy was walking with his mother; he saw a bird fly past, with
some food in its mouth.
Boy. Is not that bird hungry? for I see that he carries his meat fast
in his mouth.
Mother. She is a mother bird, and has young ones in her nest.
Boy. Who makes the nest?
Mother. The old birds.
Boy. How do they make the nests?
 Mother. Some make their nests of sticks; some of dry leaves;
some use clay; some straw: they use all sorts of things; each kind of
bird knows what is fit for its use.
Boy. What do they make nests for?
Mother. To nurse their young in.
Boy. And are they warm?
Mother. The old birds line them with moss, with wool, or with
feathers, to make them warm and soft.
Boy. Where do they get all these things?
Mother. They fly a great way to fetch them; and sometimes they
pluck their own breasts to supply down for their young to lie upon.
Boy. How kind they are!
Mother. So kind are good parents to their children.
Boy. Pray why do the birds sing?
Mother. One old bird sings whilst one sits on the eggs.
Boy. Why do they sit on the eggs?
Mother. To keep them warm, so that they may hatch.
Boy. What do you mean by that, pray, mother?
Mother. The young birds break the shells and come out.
Boy. What do they do then? do they fly?
Mother. Not at first: babes, you know, cannot walk.
Boy. But what do young birds do?
Mother. They lie in the nests, and gape for food.
Boy. And do they get it?
Mother. The old birds fly far and near to fetch it. You saw one with
some in its bill.
Boy. I see a bird now with some in its mouth.
 Mother. Do not make a noise, lest you fright the poor thing.—
Hush! hush!—let us creep gently, and see the bird go to her nest.
They saw the bird alight on a bush just by: she hopped from twig
to twig till she got to the nest: she gave the little worm which she had
in her beak to her young, and then flew away in search of more.
Boy. Now may I talk?
Mother. Yes, my dear;—are you not pleased to see the birds?
Boy. Yes, mother.—When will the little ones fly?
Mother. When they have got all their feathers.
Boy. How will they learn?
Mother. The old birds will teach them to fly as I taught you to walk.
Boy. I hope the little birds will always love their mothers. I shall
always love you; mother, pray kiss me.
 THE HAPPY FAMILY.

There were eight boys and girls of the name of Freelove; their kind
parents taught them to do as they were bid in all things. They were
the happiest children in the world; for, being used to control, they
thought it no hardship to obey their friends. When one of them had a
mind to do anything, and was not sure whether it would be right, he
went in to inquire, and was always content with the answer. If it was
proper, he was certain to have leave: and if it was not proper, he had
no longer a wish to do it, but was glad that he had asked.
Mr. and Mrs. Freelove took great pains with their children, and
taught them, as soon as they could learn, all that was proper for their
age; and they took delight in learning, so that it was a pleasure to
teach them.
Such a family is the most pleasing scene upon earth.
The children were all very fond of each other. No one had an idea
of feeling joy in which the rest did not share. If one child had an
apple, or a cake, he always parted it into eight pieces; and the owner
kept the smallest for himself; and when any little treasure was given
which could not be so divided, the rest were summoned to see it, to
play with it, and to receive all the pleasure which it could afford.
The little folks were fond of books: the elder ones would often lay
aside their own, to read aloud to the younger ones in such as were
suited to them. In short, they were a family of perfect love. Each boy
had a little piece of ground for a garden, in which he might work to
amuse himself. It would have made you smile to see how earnest
they were at their work—digging, planting, weeding, and sometimes
they had leave to water. Each was ready to lend any of his tools to
his brother. Each was happy to assist in any plan, if his brother
needed help.
The boys did the chief work in their sisters’ gardens; and their
greatest joy was to present little nosegays to their mother and
sisters.
There were sheep kept upon the lawn; the pretty creatures were
so tame that they would eat out of a person’s hand. You may believe
that the children were very fond of feeding them; they often gave
them their little barrow full of greens. There was no danger of the
little folks not thinking to perform so pleasing a task as this. One day
George was reading aloud to a younger brother, whose name was
William—‘Do as you would be done by.’
William. Pray what does that mean?
George. I will show you now; you hear the sheep bleat.
So he ran and got some greens, and gave to the sheep.
George. You see what it is to do as we would be done by; the poor
sheep are hungry and I feed them.
William. I should like to feed them; but I have no greens.
George. Here are some of mine: take some, and give to them.
William. I thank you, brother; now you do to me as you would wish
to be done by.
The next day, William saw a poor woman standing on the outside
of the iron gates. She looked pensive; and the child said:
 What do you want, poor woman?
Woman. A piece of bread; for I have had none to eat.
William had a bit in his hand; he had just begun to eat it. He
stopped, and thought to himself—If I had nothing to eat, and I saw a
person who had a great piece of bread, what should I wish?—that he
should give me some. So the good child broke off all but a very little
bit, (for he was very hungry) and said,
You shall have this bread which the maid gave me just now. We
should ‘do as we would be done by.’
Good boy! said his mother, who chanced to pass that way, come
and kiss me. William ran to his dear mother, and hugged her; saying,
I am never so happy as when you say, good boy.
Mother. I was seeking for Mary to tell her that Mrs. Lovechild has
sent to have you all go with us: but for your reward, you shall carry
the message to the rest. Go; I know it will give you great pleasure to
rejoice your brothers and sisters.
 THE FAIR.

James and Edward Franklin, with their Sisters, had leave to walk
about, and amuse themselves in a fair. They saw a great many
people who seemed very happy, many children merry and joyous,
jumping about, and boasting of their toys. They went to all the stalls
and bought little presents for those who were at home. They saw
wild beasts; peeped in show-boxes; heard drums, trumpets, fiddles,
and were as much pleased with the bustle around them, as you, my
little reader, would have been, had you been there.
Mrs. Franklin had desired them not to ride in a Merry-go-round,
lest they should fall and hurt themselves.
Did you ever see a Merry-go-round? If you never passed through
a country fair, I dare say you never did.
As they passed by, the children who were riding called, “will you
ride? will you ride?”
James. No, I thank you, we may not.
Edward. I should like it, if I might.
One girl called, “See how we ride!” One said, “O! how charming
this is!” One boy said, “You see we do not fall!”
James. I am not fearful; but my mother forbade us to ride.
One boy shouted aloud, “Come, come, you must ride; it will not be
known at home. I was bid not to ride, but you see I do.”
Just as he spoke, the part upon which he sat broke, and down he
fell.
In another part of the fair, the boys saw some children tossed
about in a Toss-about.
They were singing merrily the old nurse’s ditty:
 “Now we go up, up, up,
“Now we go down, down, down,
“Now we go backward and forward,
“Now we go round, round, round.”

The voices sounded pleasantly to Ned’s ear; his heart danced to

the notes; jumping, he called to his brother James, “Dear James!
look! if I thought our mother would like it, I would ride so.”
James. My dear Ned! I am sure that mother would object to our
riding in that.
Ned. Did you ever hear her name the Toss-about?
James. I am certain that if she had known of it, she would have
given us the same caution as she did about the Merry-go-round.
Ned paused a moment; then said, “How happy am I to have an
elder brother who is so prudent!”
James replied—“I am not less happy that you are willing to be
advised.”
When they returned home, each was eager to relate his brother’s
good conduct; each was happy to hear his parents commend them
both.
 THE STUBBORN CHILD.

Mr. Steady was walking out with his little son, when he met a boy
with a satchel on his shoulder, crying and sobbing dismally. Mr.
Steady accosted him, kindly inquiring what was the matter.
Mr. Steady. Why do you cry?
Boy. They send me to school: and I do not like it.
Mr. Steady. You are a silly boy! what! would you play all day?
Boy. Yes, I would.
Mr. Steady. None but babies do that; your friends are very kind to
you.—If they have not time to teach you themselves, then it is their
duty to send you where you may be taught; but you must take pains
yourself, else you will be a dunce.
Little Steady. Pray, may I give him my book of fables out of my
pocket?
Mr. Steady. Do, my dear.
Little Steady. Here it is—it will teach you to do as you are bid—I
am never happy when I have been naughty—are you happy?
Boy. I cannot be happy; no person loves me.
Little Steady. Why?
Mr. Steady. I can tell you why; because he is not good.
Boy. I wish I was good.
Mr. Steady. Then try to be so; it is easy; you have only to do as
your parents and friends desire you.
Boy. But why should I go to school?
Mr. Steady. Good children ask for no reasons; a wise child knows
that his parents can best judge what is proper; and unless they
choose to explain the reason of their orders, he trusts that they have
a good one; and he obeys without inquiry.
Little Steady. I will not say why again, when I am told what to do;
but will always do as I am bid immediately. Pray, sir, tell the story of
Miss Wilful.
Mr. Steady. Miss Wilful came to stay a few days with me; now she
knew that I always would have children obey me: so she did as I
bade her; but she did not always do a thing as soon as she was
spoken to; and would often whine out why?—that always seems to
me like saying—I think I am as wise as you are; and I would disobey
you if I durst.
One day I saw Miss Wilful going to play with a dog, with which I
knew it was not proper for her to meddle; and I said. Let that dog
alone.
Why? said Miss—I play with Wag, and I play with Phillis, and why
may I not play with Pompey.
I made her no answer—but thought she might feel the reason
soon.
Now the dog had been ill-used by a girl, who was so naughty as to
make a sport of holding meat to his mouth and snatching it away
again; which made him take meat roughly, and always be surly to
girls.
Soon after Miss stole to the dog, held out her hand as if she had
meat for him, and then snatched it away again. The creature
resented this treatment, and snapped at her fingers. When I met her
crying, with her hand wrapped in a napkin. “So,” said I, “you have
been meddling with the dog! Now you know why I bade you let
Pompey alone.”
Little Steady. Did she not think you were unkind not to pity her? I
thought—do not be displeased, father—but I thought it was strange
that you did not comfort her.
Mr. Steady. You know that her hand was not very much hurt, and
the wound had been dressed when I met her.
 Little Steady. Yes, father, but she was so sorry!
Mr. Steady. She was not so sorry for her fault, as for its
consequences.
Little Steady. What, father?
Mr. Steady. Her concern was for the pain which she felt in her
fingers; not for the fault which had occasioned it.
Little Steady. She was very naughty, I know; for she said that she
would get a pair of thick gloves, and then she would tease Pompey.
Mr. Steady. Naughty girl! how ill-disposed! then my lecture was
lost upon her. I bade her while she felt the smart, resolve to profit by
Pompey’s lesson; and learn to believe that her friends might have
good reasons for their orders; though they did not think it proper
always to acquaint her with them.
Little Steady. I once cut myself with a knife which I had not leave
to take; and when I see the scar, I always consider that I ought not to
have taken the knife.
Mr. Steady. That, I think, is the school-house; now go in, and be
good.
 THE PICTURES.

Mrs. Lovechild had one room in her house fitted up with books,
suited to little people of different ages.—She had likewise toys, but
they were such as would improve, as well as amuse her little friends.
The book-room opened into a gallery, which was hung with prints
and pictures, all chosen with a view to children. All designed to teach
little folks while they were young; in order that when they grew up,
they might act worthily.
There were written accounts of each picture, with which her
ladyship would often indulge good children.
Sometimes she walked about herself and explained a few of the
pictures to her little guests.
One day I chanced to be present when she was showing a few of
them to a little visiter; and I think my young reader may like to hear
what passed.
Mrs. Lovechild. That is Miss Goodchild.—I have read an account
of her, written by her mother.
Miss. Pray, madam, what was it?
Mrs. Lovechild. It is too long to repeat now, my dear; but I will tell
you a part.—She was never known to disobey her parents; never
heard to contradict her brothers or sisters; nor did she ever refuse to
comply with any request of theirs.—I wish you to read her character,
for she was a pattern of goodness.
Miss. Pray, madam, was she pretty?
Mrs. Lovechild. She had a healthful color: and her countenance
was sweet, because she was always good-humored.—That smile on
her mouth seems to say—I wish you all happy; but it was not for her
beauty, but her goodness, that she was beloved: and on that account
only did I wish for her picture.
 Miss. Pray, madam, why is that boy drawn with a frog in his hand?
Mrs. Lovechild. In memory of a kind action which he did to a poor
harmless frog.—You shall hear the whole story.—I was taking my
morning walk pretty early one day, and I heard a voice say, “Pray do
not kill it; I will give you this penny, it is all I have, and I shall not mind
going without my breakfast, which I was to have bought with it.”
“You shall not lose your meal!” exclaimed I; “nor you, naughty
boys, the punishment which you deserve for your cruel intention.”
Miss. Pray, madam, what was the good boy’s name?
Mrs. Lovechild. Mildmay! he was always a friend to the helpless.
Miss. How cruel it is in a great boy to be a tyrant!
Mrs. Lovechild. Dunces are often cruel.—My young friend
redeemed a linnet’s nest from a stupid school-fellow, by helping him
in his exercise every day for a fortnight, till the little birds were flown.
Here a servant entered the gallery, and announced company,
which put an end to Mrs. Lovechild’s account of the picture.
 THE HEDGE-HOG.
Master William Gentle was riding on the back of his dog Cæsar,
when his grandfather called to him and invited him to take a walk.
They went out together, and as they were walking, they met some
boys who had a hedge-hog, which they were going to hunt.—Mr.
Gentle ordered them to release it.—The boys pleaded that the
hedge-hog would injure the farmers by sucking their cows, and that it
therefore ought to be killed.